Accessing a body cavity through the urinary tract

Abstract

Some embodiments of the system described herein provide transvesical access to a body cavity (e.g., the peritoneum, the bladder, the ureter, the renal pelvis, or the retroperitoneum). For example, such a transvesical approach may provide access to the peritoneal cavity through an opening formed in the bladder wall or other structures in the urinary tract (e.g., ureter, renal pelvis, or the like). Thus, the transvesical approach through the bladder wall permits a surgeon to examine, conduct surgical or therapeutic procedures, or a combination thereof inside peritoneal cavity. Further, the transvesical access to the peritoneal cavity or another body cavity provides the opportunity to use flexible or rigid endoscopes, depending upon the procedure being performed.

1 . A system for transvesical access to a targeted site in a peritoneal space, comprising:
 a transvesical access sheath having a proximal end, a distal end, and a channel extending longitudinally therethrough; and   an entry mechanism having a tissue penetration surface, the entry mechanism being disposed on a distal portion of the access sheath,   wherein, when the distal portion of the transvesical access sheath is passed through the urethra and into the bladder, the tissue penetration surface is insertable into a wall of the bladder to form an opening to a peritoneal space.   
   
   
       2 . The system of  claim 1 , wherein the channel of the transvesical access sheath provides fluid communication with the peritoneal space when the distal portion of the access sheath is at least partially advanced through the opening. 
   
   
       3 . The system of  claim 2 , wherein the transvesical access sheath has a longitudinal length such that the proximal portion remains outside the urethra when the distal portion is passed through the urethra and into the bladder. 
   
   
       4 . The system of  claim 3 , further comprising one or more instruments to advance from the proximal portion of the transvesical access sheath, through the channel, and out of the distal portion. 
   
   
       5 . The system of  claim 4 , wherein the one or more instruments are advanced to one or more organs in the peritoneal space when the distal portion of the access sheath is at least partially advanced through the opening. 
   
   
       6 . The system of  claim 5 , wherein the one or more instruments comprises at least one rigid endoscope device to advance through the transvesical access sheath to the peritoneal space. 
   
   
       7 . The system of  claim 1 , wherein the entry mechanism comprises a blundt entry screw mechanism. 
   
   
       8 . The system of  claim 7 , wherein the tissue penetration surface includes one or more tissue engagement threads to engage the bladder wall after penetrating into the peritoneal space. 
   
   
       9 . The system of  claim 7 , wherein the blundt entry screw mechanism is operable to engages the bladder wall free of a sharp needle-like tip. 
   
   
       10 . The system of  claim 1 , further comprising an access apparatus having at least one sheath holder device to releasably coupled with the transvesical access sheath. 
   
   
       11 . The system of  claim 7 , wherein the access apparatus guides advancement of the transvesical access sheath when the transvesical access sheath is advanced through the urethra and into the bladder. 
   
   
       12 . The system of  claim 8 , wherein the access apparatus includes a first optics system that video monitoring of the urinary tract when the transvesical access sheath is advanced toward the bladder wall. 
   
   
       13 . The system of  claim 9 , further comprising a second optics system arranged within the channel of the transvesical access sheath so as to provide contemporaneous monitoring using both the first optics system and the second optics system d when the transvesical access sheath is advanced into the peritoneal space. 
   
   
       14 . The system of  claim 1 , wherein at least the portion of the distal end of the transvesical access sheath comprises a substantially translucent or transparent material to provide visual monitoring of the bladder wall when the tissue penetration surface is inserted into the bladder wall to form the opening to the peritoneal space. 
   
   
       15 . The system of  claim 1 , further comprising an instrument induction assembly that releasably mounts to the proximal end of the transvesical access sheath to provide a substantial seal at the proximal end of the transvesical access sheath. 
   
   
       16 . The system of  claim 1 , further comprising at least one inner sheath to advance through the channel of the transvesical access sheath and into the peritoneal space. 
   
   
       17 . The system of  claim 16 , wherein the at least one inner sheath comprises a flexible and steerable distal portion. 
   
   
       18 . The system of  claim 1 , further comprising an external access instrumentation scaffolding system arranged in proximity to the proximal end of the transvesical access sheath. 
   
   
       19 . The system of  claim 1 , further comprising an interchangeable instrument holder having a distal portion that advances through the channel of the transvesical access sheath, the distal portion of the interchangeable instrument holder being releasably attachable to two or more instruments selected from the group consisting of: a scalpel, scissors, a suturing device, a needle driver, a suture pushing device, biopsy forceps, a stapling device, a clip applier, a specimen retrieval device, a specimen morcellation device, and an intracavitary injector probe assembly. 
   
   
       20 . A method for transvesical access to a targeted site in a peritoneal space, comprising:
 passing a transvesical access sheath through the urethra and into the bladder of the urinary tract;   forming an opening in a wall of the urinary tract proximate to a peritoneal space; and   inserting at least a portion of the transvesical access sheath through the opening in wall of the urinary tract so that a channel extending through the transvesical access sheath is in communication with the peritoneal space.   
   
   
       21 . The method of  claim 20 , wherein the opening in the wall of the urinary tract is formed through a wall of a bladder adjacent the peritoneal space. 
   
   
       22 . The method of  claim 21 , further comprising providing a direct line of site from a proximal portion of the transvesical access sheath, through the channel, and to one or more organs in the peritoneal space. 
   
   
       23 . The method of  claim 20 , further comprising accessing the peritoneal space without obstructing a patient's airway with an instrument. 
   
   
       24 . The method of  claim 20 , further comprising advancing a rigid endoscope device through the transvesical access sheath to the peritoneal space. 
   
   
       25 . The method of  claim 20 , further comprising advancing a flexible endoscope device through the transvesical access sheath to the peritoneal space. 
   
   
       26 . The method of  claim 20 , wherein the inserting step occurs without caustic gastric contents to spilling into the peritoneal space. 
   
   
       27 . The method of  claim 20 , further comprising examining the external surface of stomach with one or more instruments advanced through the transvesical access sheath.